GW1--04662_Well Construction - GW1_20240809

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
I.Well Contractor Information:
Justin Marlowe 14.WATER ZONES
Well Contractor Name FROM '10 DESCRIPTION
4452-A N/A ft. N/A fL N/A
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Pheom Geotech FROM TO DIAMETER THICKNESS MATERIAL
N/A h. N/A ft. N/A N/A N/A
Company Name 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: Not Applicable FROM TO DIAMETER IIIICKNISS M%IFRIA!
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.) N/A ft. N/A it• N/A in. N/A N/A
3.Well Use(check well use): ft. ft in.
Water Supply Well: 17.SCREEN
IItt\I TO DIAME:TE:R SLAT SIZE THICKNESS MATERIAL
El Agricultural ❑Municipal/Public 18.9 ft. 28.9 ft. 2.0 'n' 0.010 sch.40 PVC
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&:UIDI N 1
Non-Water Supply Well: 0.0 ft 15.0 ft- neat cement grout pour-19 gallons
OMonitoring ❑Recovery 15.0 11. 17.0 ft bentonite pellets pour -20 pounds
Injection Well: fL rt.
❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATI:RI II, EMPLACEMENT METHOD
❑Aquifer Test ❑StormwaterDrainage 17.0 ft. 29.2 1'- no. 2 filter sand pour -
❑Experimental Technology ❑Subsidence Control ft. ft.
OGeothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
OGeothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks)
0.0 ft. 7.5 ft May Sand(SM)-reddish brown,medium,non-plastic fines,micaceous(RESI
4.Date Well(s)Completed: 6/25/2024 well ID# CLF22-307R 7.5 ft 16.0 f<• Sandy Silt(ML)-brownish red,white,non-plastic,
5a-Well Location: ft ft fine to coarse sand,micaceous[Saprolite]
Duke Energy Carolinas Not Applicable 16.0 ft- 20.0 ft. Silty Sand(SM)-yellowish brown,white.red,medium to coarse,
Facility/Owner Name Facility ID#(if applicable) ft ft non-plastic fines,micaceous[Partially Weathered Rock]
8320 NC Hwy 150, Terrell, NC 28673 20.0 ft. 28.5 ft. Well Graded Sand with Silt(SW-SM)-light brown,
Physical Address,City,and Zip it. it medium,non-plastic fines,micaceous[Saprolite]
Catawba 461803426350 21.REMARKS
County Parcel Identification No.(PIN) 28.5 to 29.2-Same description as 20.0 to 28.5 interval,observed as Partially Weathered Rock
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: pp 3%.
(if well field,one lat/long is sufficient) 22.Certification: I .` ,-.r a.-- •/ I'i
35.614566 -80.974141 wfoAgje/t-ild--e____QUIT J 5 2024 7/19/2024
6.I arc the Permanent or ❑Tem orarrwintureofCertifiedWdlCestraarrorW.NOww Date
well(s): P rc. LiE rl :s'r r 3t#�k:':9j 1�l lit
By signing this form,/hereby cerWy that the$ constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo ISA NCAC 02C.0100 or ISA NCAC 02C.02bErWe onstruction Standards and that a copy
If this is a repair,fill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under#21 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary.
drilled:Not Applicable
24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 28•9 (ft.)
For multiple wells list all depths ifdierent(example-3@200'and 2@I00') Submit this GW-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 25.0 (ft) 24a. For All Wells: Original form to Division of Water Resources (DWR),
If water level is above casing,use" Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 7.0 (in.) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(IUC)
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method: Hollow Stem Auger
24c.For Water Supply and Open-Loop Geothermal Return NN ells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) Method of test: Permit Program,1611 MSC,Raleigh,NC 276i99-1611
13b.Disinfection type: Amount:
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018

Monitoring Well Construction Form
S&ME Project: Marshall Well Replacements Project Number: 21410007, Ph. 02
Driller/Company:Justin Marlowe/Phenom Geotech Well Installation Method:Hollow Stem Augers WELL NO.
Drill Rig:Mobile B-57(tracked) Borehole Diameter(in.):7.0 CLF22-307R
Start Date:6/25/24 Northing(ft):684435.19 Reference Point for Measurements:Below Ground Surface(BGS)
Completion Date:6/25/24 Easting(ft):1413298.66 Depth to Water(ft.BGS):21.8 Date:6/27/24
Height of casing stick-up above ground surface(ft): 3.2 DEPTH
Height of concrete pad above ground surface(in): 2.0 (In feet)
Concrete pad thickness(in): 4.0
Ground Surface(Elevation 804.3') 0
Protective Surface Casing
Size(in): 4 x 4
>:" I
Type: Steel
Bottom of Protective Surface Casing 1.8
Backfill Material — Riser Casing
Type: neat cement grout Type: sch.40 PVC
Dia (in): 2
Top of Annular Seal 15.0
Annular Seal )11
Type: bentonite pellets Top of Filter Pack 17.0
Top of Screen 18.9
Screen Type
Dia (in): 2 < Filter Pack
Type: sch.40 PVC(pre-packed) Type: no.2 filter sand
Slot(in): 0.010
Bottom of Screen 28.9
Bottom of Sump 29.2
Bottom of Hole 29.2